Healthcare Provider Details

I. General information

NPI: 1396477485
Provider Name (Legal Business Name): YANG DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PAGE ST
COTATI CA
94931-4314
US

IV. Provider business mailing address

7 PAGE ST
COTATI CA
94931-4314
US

V. Phone/Fax

Practice location:
  • Phone: 707-665-6122
  • Fax: 707-262-9146
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BRASIL
Title or Position: OWNER/RDHAP
Credential: RDHAP
Phone: 707-548-2789